Asuman Derek, Ackah Charles Godfred, Enemark Ulrika
Institute of Statistical, Social and Economic Research, University of Ghana, E.N. Omaboe Building, P. O. Box LG 74, Legon, Ghana.
Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus C, Denmark.
Health Econ Rev. 2018 Apr 11;8(1):9. doi: 10.1186/s13561-018-0193-7.
Childhood vaccination has been promoted as a global intervention aimed at improving child survival and health, through the reduction of vaccine preventable deaths. However, there exist significant inequalities in achieving universal coverage of child vaccination among and within countries. In this paper, we examine rural-urban inequalities in child immunizations in Ghana. Using data from the recent two waves of the Ghana Demographic and Health Survey, we examine the probability that a child between 12 and 59 months receives the required vaccinations and proceed to decompose the sources of inequalities in the probability of full immunization between rural and urban areas. We find significant child-specific, maternal and household characteristics on a child's immunization status. The results show that children in rural areas are more likely to complete the required vaccinations. The direction and sources of inequalities in child immunizations have changed between the two survey waves. We find a pro-urban advantage in 2008 arising from differences in observed characteristics whilst a pro-rural advantage emerges in 2014 dominated by the differences in coefficients. Health system development and campaign efforts have focused on rural areas. There is a need to also specifically target vulnerable children in urban areas, to maintain focus on women empowerment and pay attention to children from high socio-economic households in less favourable economic times.
儿童疫苗接种已被推广为一项全球干预措施,旨在通过减少疫苗可预防的死亡来提高儿童存活率和健康水平。然而,在实现各国之间及各国国内儿童疫苗接种的普遍覆盖方面存在显著不平等。在本文中,我们研究了加纳儿童免疫接种中的城乡不平等问题。利用加纳人口与健康调查最近两轮的数据,我们考察了12至59个月大的儿童接种所需疫苗的概率,并进而剖析城乡地区完全免疫概率不平等的根源。我们发现儿童特定、母亲及家庭特征对儿童免疫状况有显著影响。结果表明,农村地区的儿童更有可能完成所需疫苗接种。两轮调查期间,儿童免疫接种不平等的方向和根源发生了变化。我们发现,2008年因观察到的特征差异而出现有利于城市的优势,而2014年则出现有利于农村的优势,这主要由系数差异所致。卫生系统发展和宣传工作一直侧重于农村地区。还需要特别针对城市地区的弱势儿童,继续注重赋予妇女权力,并在经济形势不利时关注来自高社会经济家庭的儿童。